Assessment of Perceptions of Mental Health vs Medical Health Plan Networks Among US Adults With Private Insurance
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ABSTRACT:
SUBMITTER: Busch S
PROVIDER: S-EPMC8536951 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ImportanceRehospitalization after major surgery is common and represents a significant cost to the health care system. Little is known regarding the causes of these readmissions and the degree to which they may be preventable.ObjectiveTo evaluate the degree to which readmissions after major surgery are potentially preventable.Design, setting, and participantsThis retrospective cohort study used a weighted sample of 1 937 354 patients from the 2017 National Readmissions Database to evaluate all adult inpatient hospitalizations for 1 of 7 common major surgical procedures. Statistical analysis was performed from January 14 to November 30, 2020.Main outcomes and measuresThe study calculated 90-day readmission rates as well as rates of readmissions that were considered potentially preventable. Potentially preventable readmissions (PPRs) were defined as those with a primary diagnosis code for superficial surgical site infection, acute kidney injury, aspiration pneumonitis, or any of the Agency for Healthcare Research and Quality-defined ambulatory care sensitive conditions. Multivariable logistic regression was used to identify factors associated with PPRs.ResultsA total weighted sample of 1 937 354 patients (1 048 046 women [54.1%]; mean age, 66.1 years [95% CI, 66.0-66.3 years]) underwent surgical procedures; 164 755 (8.5%) experienced a readmission within 90 days. Potentially preventable readmissions accounted for 29 321 (17.8%) of all 90-day readmissions, for an estimated total cost to the US health care system of approximately $296 million. The most common reasons for PPRs were congestive heart failure exacerbation (34.6%), pneumonia (12.0%), and acute kidney injury (22.5%). In a multivariable model of adults aged 18 to 64 years, patients with public health insurance (Medicare or Medicaid) had more than twice the odds of PPR compared with those with private insurance (adjusted odds ratio, 2.09; 95% CI, 1.94-2.25). Among patients aged 65 years or older, patients with private insured had 18% lower odds of PPR compared with patients with Medicare as the primary payer (adjusted odds ratio, 0.82; 95% CI, 0.74-0.90).Conclusions and relevanceThis study suggests that nearly 1 in 5 readmissions after surgery are potentially preventable and account for nearly $300 million in costs. In addition to better inpatient care, improved access to ambulatory care may represent an opportunity to reduce costly readmissions among surgical patients.
| S-EPMC8044735 | biostudies-literature
Project description:BackgroundAfter achieving universal basic medical insurance coverage, Chinese government put the development of private health insurance (PHI) on its agenda to further strengthen financial risk protection. This paper aims to assess the level of financial protection that PHI provides for its insured households on the basis of resident basic medical insurance (RBMI).MethodsWe employed balanced panel data collected between 2015 and 2017 from the China Household Finance Survey (CHFS). Catastrophic health expenditure (CHE) and impoverishment due to health spending were applied to measure the financial protection effects. Random effects panel logistic regression model was performed to identify the factors associated with CHE and impoverishment among households covered by RBMI. In the robustness test, the method of propensity score matching (PSM) was employed to solve the problem of endogeneity.ResultsFrom 2015 to 2017, the CHE incidence increased from 12.96 to 14.68 % for all sampled households, while the impoverishment rate decreased slightly from 5.43 to 5.32 % for all sampled households. In 2015, the CHE incidence and impoverishment rate under RBMI + PHI were 4.53 and 0.72 %, respectively, which were lower than those under RBMI alone. A similar phenomenon was observed in 2017. Regression analysis also showed that the households with RBMI + PHI were significantly less likely to experience CHE (marginal effect: -0.054, 95 %CI: -0.075 to -0.034) and impoverishment (marginal effect: -0.049, 95 %CI: -0.069 to -0.028) compared to those with RBMI alone. The results were still robust after using PSM method to eliminate the effects of self-selection on the estimation results.ConclusionsIn the context of universal basic medical insurance coverage, the CHE incidence and impoverishment rate of Chinese households with RBMI were still considerably high in 2015 and 2017. PHI played a positive role in decreasing household financial risk on the basis of RBMI.
| S-EPMC8130397 | biostudies-literature
Project description:This study aimed to investigate pediatric health access by describing the ecology of medical care for children and adolescents in a medical environment where a well-balanced system between national health insurance (NHI) and private medical insurance (PMI) is required. Data from 2746 individuals aged 18 years old and younger were used. Of the participants, 87.3% had private medical insurance. Of the 1000 children, in an average month, 404 visited a clinic, 67 visited a hospital outpatient department (OPD), 49 visited an OPD in a tertiary hospital, 11 received emergency care, 5 received inpatient care in a hospital, and 9 were hospitalized. The generalized estimating equation models adjusted for age, sex, economic status, and pediatric comorbidity index were used for multivariate analysis. Receiving ambulatory care services in clinics was significantly more likely among children and adolescents with private medical insurance (adjusted odds ratio [aOR] = 1.16 [95% confidence interval [CI]: 1.00-1.35]). Receiving ambulatory care services in clinics was significantly more likely among indemnity type policyholders (aOR = 1.23 [1.05-1.45]) and single policyholders (aOR = 1.18 [1.00-1.37]). Countries with national health insurance schemes should continuously practice the proper regulation and management of PMI, including reviewing PMI compensation measures, NHI reimbursement standards, and consumers' perspectives on NHI and PMI.
| S-EPMC9330897 | biostudies-literature
Project description:ObjectivesThis study evaluated the impact of private insurance coverage on the symptoms of depression, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) in the years leading up to Medicare eligibility focusing on the transition from full-time work to early full retirement.MethodThe Health and Retirement Study was used to (a) estimate 2-stage selection equations of (i) the transition to retirement and (ii) current insurance status, and (b) the impact of insurance coverage on health, net of endogeneity associated retirement and insurance coverage.ResultsEmployment-based insurance coverage was generally associated with better health. Moreover, being without employment-based insurance was particularly problematic during the transition to retirement. Non-group insurance only moderated the association between losing employment-based insurance and IADLs.DiscussionResults indicated that private insurance coverage is an important contextual factor for the health of early retirees. Those who maintain steady coverage tend to fare the best in retirement. This highlights the dynamic nature of changes in health in later life.
| S-EPMC5014243 | biostudies-literature
Project description:Competition in health insurance markets may fail to improve health outcomes if consumers are not able to identify high quality plans. We develop and apply a novel instrumental variables framework to quantify the variation in causal mortality effects across plans and how much consumers attend to this variation. We first document large differences in the observed mortality rates of Medicare Advantage plans within local markets. We then show that when plans with high (low) mortality rates exit these markets, enrollees tend to switch to more typical plans and subsequently experience lower (higher) mortality. We derive and validate a novel "fallback condition" governing the subsequent choices of those affected by plan exits. When the fallback condition is satisfied, plan terminations can be used to estimate the relationship between observed plan mortality rates and causal mortality effects. Applying the framework, we find that mortality rates unbiasedly predict causal mortality effects. We then extend our framework to study other predictors of plan mortality effects and estimate consumer willingness to pay. Higher spending plans tend to reduce enrollee mortality, but existing quality ratings are uncorrelated with plan mortality effects. Consumers place little weight on mortality effects when choosing plans. Good insurance plans dramatically reduce mortality, and redirecting consumers to such plans could improve beneficiary health.
| S-EPMC8409169 | biostudies-literature
Project description:BackgroundArthroscopic rotator cuff repair is an effective treatment for patients with symptomatic rotator cuff tears. Ensuring timely and appropriate postoperative access to physical therapy (PT) is paramount to the achievement of optimal patient outcomes. Extended immobility due to a lack of formal rehabilitation can lead to decreased range of motion, continued pain, and potential reoperation for stiffness. The purpose of this study is to evaluate national disparities in access to PT services after rotator cuff repair between patients with private vs. Medicaid insurance. This study will further evaluate differences in access to PT services between states that have previously undergone Medicaid expansion as compared with those states which have not.MethodsThe American Physical Therapy Association Website was used to identify 10 physical therapy practices from the capital city in every state. Each physical therapy practice was contacted using a mock-patient script for a patient with Medicaid insurance or private (Blue Cross Blue Shield) insurance. To maintain anonymity, calls were made by two separate investigators. Univariate analysis included independent sample t-test for differences between the study groups for continuous variables. Chi square or Fisher's exact test assessed differences in discrete variables between the study groups.ResultsContact was made with 465 of 510 (91.2%) physical therapy practices. Overall, 52.7% accepted Medicaid insurance, while 94.9% accepted private insurance (P < .001). Medicaid insurance was more likely to be accepted in a Medicaid expansion state than a nonexpansion state (56.1% vs. 46.3%, P = .05). Private insurance was also more likely to be accepted in a Medicaid expansion state than a nonexpansion state (96.7% vs. 91.3%, P = .01). The time to first appointment varied more in Medicaid expansion states (private range: 0-43 days, Medicaid range: 0-72 days) than in nonexpansion states (private range: 0-11 days, medicaid range: 0-10 days).ConclusionSignificantly fewer PT practices accepted Medicaid insurance nationally compared with private insurance, which suggests that patients with Medicaid insurance have greater difficulty accessing PT after rotator cuff repair in the United States compared with patients with private insurance. While Medicaid insurance was more likely to be accepted in a Medicaid expansion state, this finding was only borderline significant, which indicates that patients in Medicaid expansion states are still having difficulty accessing PT, despite efforts to expand government insurance coverage to improve access to care. Orthopedic surgeons should counsel their patients with Medicaid insurance to seek out PT as early as possible in the postoperative period to avoid delays in rehabilitation.
| S-EPMC8178595 | biostudies-literature
Project description:Older adults with multiple chronic conditions have a higher risk than those without multiple conditions of developing a mental health condition. Individuals with both physical and mental conditions face many substantial burdens. Many such individuals also belong to racial and ethnic minority groups. Private insurance coverage can reduce the risks of developing mental illnesses by increasing healthcare utilization and reducing psychological stress related to financial hardship. This study examines the association between private insurance and mental health (i.e., depressive symptoms and cognitive impairment) among older adults in the United States with multiple chronic conditions by race and ethnicity. We apply a multivariate logistic model with individual fixed-effects to 12 waves of the Health and Retirement Study. Among adults with multiple chronic conditions in late middle age nearing entry to Medicare and of all racial and ethnic groups, those without private insurance have a stronger probability of having depressive symptoms. Private insurance and Medicare can mediate the risk of cognitive impairment among non-Hispanic Whites with multiple chronic conditions and among Blacks regardless of the number of chronic conditions. Our study has implications for policies aiming to reduce disparities among individuals coping with multiple chronic conditions.
| S-EPMC7967527 | biostudies-literature
Project description:OBJECTIVE: To assess the effects of transitions from private to public health insurance by children on out-of-pocket medical expenditures and health insurance premium costs. DATA SOURCES: Data are drawn from the 1996 and 2001 panels of the Survey of Income and Program Participation. We construct a nationally representative, longitudinal sample of children, ages 0-18, and their families for the period 1998-2003, a period in which states raised public health insurance eligibility rates for children. STUDY DESIGN: We exploit the Survey of Income and Program Participation's longitudinal design to identify children in our sample who transition from private to public health insurance. We then use a bootstrapped instrumental variable approach to estimate the effects of these transitions on out-of-pocket expenditures and health insurance premium costs. PRINCIPAL FINDINGS: Children who transition from private to public coverage are relatively low-income, are disproportionately likely to live in single-mother households, and are more likely to be Black or of Hispanic origin. Child health status is highly predictive of transitions. We estimate that these transitions provide a cash-equivalent transfer of nearly U.S.$1,500 annually for families in the form of reduced out-of-pocket and health insurance premium costs. CONCLUSIONS: Transitions from private to public health coverage by children can bring important social benefits to vulnerable families. This suggests that instead of being a net societal cost, such transitions may provide an important social benefit.
| S-EPMC3097405 | biostudies-other
Project description:In South Korea, people may increase their medical coverage by purchasing private health insurance to augment low coverage provided by the National Health Insurance (NHI). Frequent and excessive use of medical care by those with private health insurance is an issue, especially for musculoskeletal disorders that require excessive care and contribute to moral hazard. In South Korea, since private health insurance is structurally linked to the scope of coverage with public health insurance, this increased use of medical care may adversely affect public health insurance finances. This study aimed to analyze the effects of private health insurance on medical care use for patients with musculoskeletal disorders. We used the Korea Health Panel 2014 to 2015 data that included 5622 participants who used medical care for musculoskeletal disorders in 2015. Two groups were created: those who purchased private health insurance (n = 3588) and those without private insurance (n = 2034). We compared their medical utilization using logistic regression, negative binomial regression, and multiple linear regression to determine the associations of private health insurance with medical care use. Medical expenditures by private health insurance purchasers were higher than those of non-purchasers for outpatient care (P < .001), but no differences were found for inpatient care. Our findings suggest that the expansion of private health insurance further burdened the NHI financially, ultimately increasing the burden of medical expenses for the population. Research should implement demonstration studies with different groups of diseases.
| S-EPMC7756039 | biostudies-literature
Project description:ObjectiveTo examine how plan premiums are associated with physician network breadth, hospital network breadth, and hospital network quality on the Affordable Care Act's Health Insurance Marketplaces in all 50 states and the DC in 2016.Data sourcesData on plan premiums and characteristics came from 2016 Robert Wood Johnson Foundation Health Insurance Exchange (HIX) Compare. Provider network information was obtained from Vericred. Hospital characteristics were obtained from CMS Hospital Compare and the American Hospital Association (AHA) survey.Study designWe analyzed how plan premiums were associated with variations in physician network breadth, hospital network breadth, and hospital network quality using ordinary least square regressions with state-rating area fixed effects and carrier fixed effects.Principal findingsPlan premiums were positively associated with physician network breadth and hospital network breadth. We find the following statistically significant results: a one standard deviation increase in physician network breadth was linked to a premium increase of 2.8 percent or $101 per year; a one standard deviation increase in hospital network breadth was linked to a premium increase of 2.4 percent or $86 per year. There was no significant association between premiums and hospital network quality, as measured by hospital star ratings and the inclusion of teaching hospitals or the top-20 hospitals nationwide.ConclusionsPhysician network breadth and hospital network breadth contributed positively to plan premiums. The roles of the two types of provider network breadth are quantitatively similar. Premiums appear to be insensitive to hospital network quality.
| S-EPMC7839649 | biostudies-literature